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International Urogynecology Journal

, Volume 23, Issue 9, pp 1187–1192 | Cite as

Intravesical hyaluronic acid and chondroitin sulphate for bladder pain syndrome/interstitial cystitis: long-term treatment results

  • M. Cervigni
  • F. Natale
  • L. Nasta
  • A. Mako
Original Article

Abstract

Introduction and hypothesis

Reconstruction of the glycosaminoglycan layer plays a role in the successful treatment of bladder pain syndrome/interstitial cystitis (BPS/IC). Intravesical instillations of hyaluronic acid (HA) and chondroitin sulphate (CS) have given results in the short term. We hypothesise that these benefits continue in the longer term.

Methods

With the aim of evaluating this therapy over a longer period we treated 12 BPS/IC patients refractory to other treatments with a combination of HA 1.6 % and CS 2.0 % over a period of 3 years assessing symptoms and quality of life using a visual analogue scale, 3-day voiding diaries and validated questionnaires.

Results

Improvements in bladder function were sustained for 3 years (mean number of daily voids decreased from 17.8 at baseline to 15.5 at 9 months and 11.9 at 3 years, and mean volume per void from 136.8 ml at baseline to 143.9 ml at 9 months and 180.9 ml at 3 years). Quality of life assessments confirmed these improvements.

Conclusions

Intravesical instillations of HA and CS produced a sustained improvement of the symptomatology, up to 3 years, in patients with BPS/IC refractory to previous treatments. Further confirmation would be expected from larger controlled trials.

Keywords

Bladder pain syndrome Interstitial cystitis Hyaluronic acid Chondroitin sulphate Intravesical treatment 

Notes

Acknowledgements

Thanks go to David Nicholson for assistance with native English.

Conflicts of interest

M. Cervigni: Consultant for Medtronic and Bard, Speaker for IBSA. F. Natale, L. Nasta and A. Mako: none.

References

  1. 1.
    Chancellor MB, Yoshimura N (2004) Treatment of interstitial cystitis. Urology 63(3 Suppl 1):85–92PubMedCrossRefGoogle Scholar
  2. 2.
    Phatak S, Foster HE Jr (2006) The management of interstitial cystitis: an update. Nat Clin Pract Urol 3(1):45–53PubMedCrossRefGoogle Scholar
  3. 3.
    van de Merwe JP, Nordling J, Bouchelouche P, Bouchelouche K, Cervigni M et al (2008) Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol 53(1):60–67PubMedCrossRefGoogle Scholar
  4. 4.
    Toft BR, Nordling J (2006) Recent developments of intravesical therapy of painful bladder syndrome/interstitial cystitis: a review. Curr Opin Urol 16(4):268–272PubMedCrossRefGoogle Scholar
  5. 5.
    Iavazzo C, Athanasiou S, Pitsouni E, Falagas ME (2007) Hyaluronic acid: an effective alternative treatment of interstitial cystitis, recurrent urinary tract infections, and hemorrhagic cystitis? Eur Urol 51(6):1534–1540PubMedCrossRefGoogle Scholar
  6. 6.
    Patel BN, Evans RJ (2010) Overactive bladder and pain: management strategies. Curr Urol Rep 11(6):379–384PubMedCrossRefGoogle Scholar
  7. 7.
    Cervigni M, Natale F, Nasta L, Padoa A, Voi RL, Porru D (2008) A combined intravesical therapy with hyaluronic acid and chondroitin for refractory painful bladder syndrome/interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct 19:943–947PubMedCrossRefGoogle Scholar
  8. 8.
    Gillenwater JY, Wein AJ (1988) Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, August 28–29, 1987. J Urol 140(1):203–206PubMedGoogle Scholar
  9. 9.
    Lubeck DP, Whitmore K, Sant GR, Alvarez-Horine S, Lai C (2001) Psychometric validation of the O’Leary-Sant interstitial cystitis symptom index in a clinical trial of pentosan polysulfate sodium. Urology 57:62–66PubMedCrossRefGoogle Scholar
  10. 10.
    Brewen ME, White WM, Klein FA, Klein LM, Waters WB (2007) Validity of Pelvic Pain, Urgency, and Frequency questionnaire in patients with interstitial cystitis/painful bladder syndrome. Urology 70(4):646–649CrossRefGoogle Scholar
  11. 11.
    Riedl CR, Engelhardt PF, Daha KL et al (2008) Hyaluronan treatment of interstitial cystitis/painful bladder syndrome. Int Urogynecol J Pelvic Floor Dysfunct 19(5):717–721PubMedCrossRefGoogle Scholar
  12. 12.
    Karsenty G, AlTaweel W, Hajebrahimi S, Corcos J (2006) Efficacy of interstitial cystitis treatments: a review. EAU-EBU Update Ser 4:47–61CrossRefGoogle Scholar
  13. 13.
    Engelhardt PF, Morakis N, Daha LK, Esterbauer B, Riedl CR (2011) Long-term results of intravesical hyaluronan therapy in bladder pain syndrome/interstitial cystitis. Int Urogynecol J 22(4):401–405PubMedCrossRefGoogle Scholar
  14. 14.
    Parsons CL, Housely T, Schmidt JD et al (1994) Treatment of interstitial cystitis with intravesical heparin. Br J Urol 73:504–507PubMedCrossRefGoogle Scholar
  15. 15.
    Davis EL, El Khoudary SR, Talbott EO et al (2008) Safety and efficacy of the use of intravesical and oral pentosan polysulfate sodium for interstitial cystitis: a randomized double-blind clinical trial. J Urol 179(1):177–185PubMedCrossRefGoogle Scholar
  16. 16.
    Daha LK, Riedl CR, Lazar D et al (2005) Do cystometric findings predict the results of intravesical hyaluronic acid in women with interstitial cystitis? Eur Urol 47:393–397PubMedCrossRefGoogle Scholar
  17. 17.
    Gupta S, Pidcock L, Parr NJ (2005) The potassium sensitivity test: a predictor of treatment response in interstitial cystitis. BJU Int 96:1063–1066PubMedCrossRefGoogle Scholar
  18. 18.
    Kallestrup EB, Jorgensen SS, Nordling J et al (2005) Treatment of interstitial cystitis with Cystistat: a hyaluronic acid product. Scand J Urol Nephrol 39:143–147PubMedCrossRefGoogle Scholar
  19. 19.
    Leppilahti M, Hellström P, Tammela TL (2002) Effect of diagnostic hydrodistension and four intravesical hyaluronic acid instillations on bladder ICAM-1 intensity and association of ICAM-1 intensity with clinical response in patients with interstitial cystitis. Urology 60:46–51PubMedCrossRefGoogle Scholar
  20. 20.
    Porru D, Campus G, Tudino D et al (1997) Results of treatment of refractory interstitial cystitis with intravesical hyaluronic acid. Urol Int 59:26–29PubMedCrossRefGoogle Scholar
  21. 21.
    Morales A, Emerson L, Nickel JC (1996) Treatment of refractory interstitial cystitis. Int Urogynecol J Pelvic Floor Dysfunct 7:215–220PubMedCrossRefGoogle Scholar
  22. 22.
    Palylyk-Colwell E (2006) Chondroitin sulfate for interstitial cystitis. Issues Emerg Health Technol 84:1–4PubMedGoogle Scholar
  23. 23.
    Steinhoff G (2003) The efficacy of chondroitin sulphate in treating interstitial cystitis. Eur Urol Suppl 2:14–16CrossRefGoogle Scholar
  24. 24.
    Nickel JC, Egerdie B, Downey J et al (2008) A real-life multicentre clinical practice study to evaluate the efficacy and safety of intravesical chondroitin sulphate for the treatment of interstitial cystitis. BJU Int 103(1):56–60PubMedCrossRefGoogle Scholar
  25. 25.
    Porru D, Cervigni M, Nasta L et al (2008) Results of endovesical hyaluronic acid/chondroitin sulfate in the treatment of interstitial cystitis/painful bladder syndrome. Rev Recent Clin Trials 3:126–129PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  1. 1.Department of UrogynecologySan Carlo HospitalRomeItaly
  2. 2.Italian Interstitial Cystitis AssociationRomeItaly

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